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December 14, 2017

Relishing Motherhood After Battling Advanced Breast Cancer

By SharingMayoClinic

When she found out her breast cancer had come back, Luciana Farfalli, M.D., faced an uncertain future. But care at Mayo Clinic put the cancer in remission and allowed her to turn her attention back to the family she adores.

"I'm so grateful for Andresito. He is the source of life for me," Luciana Farfalli, M.D., says of her 2-year-old son. "The best part of my day is when he wakes up, comes looking for me and gives me a big hug."

Luciana, a pediatric dermatologist originally from Argentina, says traveling back to her home country with her husband and son for Andresito's baptism, and being able to spend time with family and close friends during the trip, was an amazing gift. It was one she wasn't sure she'd receive after being diagnosed with metastatic breast cancer in March 2016 and receiving a dim prognosis.

But a second opinion at Mayo Clinic with surgeon James Jakub, M.D., turned it all around for Luciana and her family.

"Dr. Jakub was the light at the end of the tunnel. He was very warm and kind," Luciana says. "I was so tired of hearing about what stage of cancer I had and what my life expectancy was. He was the first one who told me, 'We're going to get rid of that cancer.' I'll never forget those words."

A frightening turn of events

When she was 26 years old, Luciana was diagnosed and treated for stage one breast cancer. For five years after that, she received follow-up care, and there was no sign of the cancer coming back. During that time, Luciana met her husband, Andres Cruz, M.D., who was a resident in dermatology at Mayo Clinic's Rochester campus, while she was on a visiting physician rotation there. They began dating and eventually got married. Their son, Andresito, was born in September 2015.

The following January, Luciana started to feel pain in her right shoulder while breastfeeding. The pain got worse and kept her up at night. She couldn't feed her baby or push the stroller. An MRI revealed a large mass under her arm. It was aggressive recurrent breast cancer. Surgeons in San Diego, where the family lives, told them Luciana's cancer had spread to her liver, and she was not a surgical candidate.

"I was looking at being a single parent," Andres says. "It was all happening quickly."

"He was the first one who told me, 'We're going to get rid of that cancer.' I'll never forget those words." — Luciana Farfalli

Several of Andres' family members had been treated at Mayo Clinic for cancer, so he got in touch with Dr. Jakub, chair of the Division of Breast, Endocrine, Metabolic and Gastroenterologic Surgery, for a second opinion. When they arrived at Mayo Clinic, additional tests revealed that most of the spots on Luciana's liver that had lit up on a PET scan in San Diego were actually hepatic angiomas — benign blood vessel growths, and not cancer.

"We headed to Mayo in March 2016 with the baby thinking, 'Luciana has liver cancer,'" Andres says. "When the liver biopsy came back benign, we were so relieved."

During a physical exam, however, Dr. Jakub could feel an area at the base of Luciana's neck that concerned him. He told the Luciana and Andres he thought the cancer may have spread to a lymph node. His suspicion was confirmed with a needle biopsy. Further imaging showed the tumor under her arm was obstructing the axillary vein, which drains the arm, and it was pushing against the artery and nerves.

A path to remission

Luciana would need several rounds of chemotherapy to shrink the tumor away from the important nerves and blood vessels under her arm and treat other cancer cells. After that, Dr. Jakub would assemble a multidisciplinary team from breast imaging, medical oncology, radiation oncology, vascular surgery, and plastic and reconstructive surgery in preparation for the procedure to remove Luciana's tumor.

"We needed a plastic surgeon because we were going to have to remove a piece of a nerve that was involved with the tumor — a nerve that went to one of her back muscles — and the plastic reconstructive surgeon would need to repair it," Dr. Jakub says.

In August 2016, after four rounds of chemotherapy, a PET scan showed the tumor in Luciana's neck was gone. She had surgery on Sept. 27, 2016, to remove the mass in her armpit. She then completed six weeks of radiation treatment on her neck and armpit. The treatment achieved its goal, and Luciana's cancer is now in remission.

A time to move forward

With treatment behind her, Luciana has spent 2017 delighting in her son's emerging personality — most recently his infectious sense of humor and his love for singing along with music.

"We went to Disneyland with my sister and Andresito's cousins. Watching him laugh and run and jump around just filled my heart," Luciana says. "Andresito's energy and love enable me to see the light and breathe each and every day."

In April, Luciana also fulfilled a lifelong dream to see Celine Dion perform live. “I’ve loved her music since I was 15," she says. "The concert, and our whole trip to Las Vegas, was amazing."

"Mayo Clinic is like a five-star hotel in terms of the medical care you receive." — Luciana Farfalli

The exceptional care Dr. Jakub and the rest of her team provided gives Luciana an added sense of gratitude for these memorable times.

"I don't think I would have had those experiences were it not for the entire medical team that treated me. Mayo Clinic is like a five-star hotel in terms of the medical care you receive," Luciana says.

"I’m also extremely grateful for the support and care I got from my family," she adds. "My husband never left my side. My mother traveled from Argentina and stayed with us for six months to take care of me and help care for Andresito. If there is a silver lining to all of this, it was the strong bond that they formed."

Knowing that Luciana has been able to move forward and find joy in her family and her life after cancer treatment gives her care team great satisfaction.

"The pictures Dr. Farfalli sent of her son's birthday and the family's New Year celebration mean the world to me," says Dr. Jakub. "Those are the things that make me enjoy doing what I do."